17th International Conference on Malignant Lymphoma, Palazzo dei Congressi, Lugano, Switzerland, 13 - 17 June, 2023.

Abstract

Introduction: Lymphoma is one of the most prevalent cancers diagnosed in the Republic of Ireland, with approximately 800 cases of Non-Hodgkin lymphoma and 150 cases of Hodgkin lymphoma (HL) diagnosed annually. Previous studies have demonstrated that time to diagnosis can range substantially, with diagnosis to treatment interval associated with survival outcomes. Aims & Methods: The primary aim of this study was to compare the diagnostic efficiency according to histology specimen type. The secondary aims included time to lymphoma diagnosis, and predictors associated with diagnostic delays. A retrospective analysis was performed on all patients diagnosed at a tertiary (non-fee paying) centre in Ireland between 2016 and 2021. Baseline demographic data and diagnostics were obtained from electronic records. Referral to treatment interval (RTI) was calculated from the date of initial review in the referral centre to commencement of therapy. Results: A total of 225 new lymphoma diagnoses were made during the study period. The median age was 63.3 years (IQR 44.2, 73.6) Males accounted for 54.7% (n = 123) of the population. DLBCL was the most common subtype (n = 94; 41.8%); followed by classical HL (n = 40; 17.8%) and Follicular lymphoma (n = 32; 14.2%). Fifty four percent (n = 122) had their diagnostic histology attained during an inpatient episode. The median time to diagnosis was 24 days (IQR 13.0, 58.0). A total of 350 histology specimens were attained. Core biopsy yielded a diagnosis in 64% (n = 144), excision biopsy in 35.6% (n = 80) and FNA in 0.4% (n = 1). The positive diagnostic rate was 69.5% for core biopsy, 93% for excision biopsy and 1.7% for FNA. The median financial cost of diagnosis was €13714 (IQR €4050, €24044). The total cost for this patient group was €3.7 million over a 5 year period. The median RTI was 47 days (IQR 23.0, 91.0). In the univariate analysis, we confirmed patients with older age are more likely to have longer RTI (p = 0.0007). Diagnostic biopsy performed as inpatient was associated with a shorter RTI (p ≤ .0001). Patients referred direct to haematology services had a longer RTI (p = 0.0004). In the multivariable analysis, patients with older age remained significant associated with prolonged RTI (p = 0.0251). Diagnostic biopsy performed as an inpatient remained significant (p ≤ .0001). Similarly, patients referred directly to Haematology services has significantly longer RTI (p = 0.0051). Conclusion: In this review, we confirm the higher diagnostic yield of excision biopsy for diagnosis. Older age at presentation and referral direct to haematology was associated with longer RTI. Inpatient diagnostic’s was associated with shorter RTI. We confirm an over reliance on inpatient diagnostics. With the increasing financial burden of healthcare and increased demand on resources including bed utilisation, the appropriate choice of investigations and diagnostic sampling is ever more critical. Encore Abstract - previously submitted to regional or national meetings (up to <1000 attendees) Keywords: cancer health disparities, diagnostic and prognostic biomarkers, Imaging and Early Detection - Other No conflicts of interests pertinent to the abstract.